OBJECTIVES: The presence of adverse events (AEs) associated with topical rosacea agents may lead to a lack of treatment adherence. Previous studies have reported low adherence rates among treated rosacea patients. This study describes the rate of treatment changes due to AEs and associated healthcare costs among rosacea patients receiving a topical therapy. METHODS: Patients diagnosed with rosacea (ICD-9-CM: 695.3) who are newly initiating treatment with topical metronidazole, azelaic acid, sodium sulfacetamide/sulfur, benzoyl peroxide between 1/2009 and 10/2013 were identified from MarketScan databases. Patients were required to be ≥30 years old, continuously eligible with medical and pharmacy benefits ≥12 months pre- and ≥3 months post-treatment and without evidence of oral antibiotic or rosacea conjunctivitis during the study period. An AE was defined as a treatment switch within 2 weeks or medical claim with an AE diagnosis code. Persistence was defined as continuous refill of the index drug/formulation within 1.5 times the days’ supply of the prior prescription. Rate of AEs, treatment patterns, and healthcare costs were evaluated in the post-index period.  RESULTS: This analysis included 49,351 patients. The mean age was 54 years and 25.5% were male. Metronidazole (72.7%) was the most common treatment and the predominant formulation was gel (70.4%). Approximately 6,270 (12.7%) had a coded AE. Of the AE patients, 3.2% were persistent with treatment despite the AE, 7.4% switched to another treatment within 8.8 days, and 89.4% discontinued therapy within 31.1 days. AE patients incurred $325 (medical: $143, pharmacy: $182) in rosacea-related costs, while patients without AEs incurred $172 (medical: $14, pharmacy: $157). CONCLUSIONS: The majority of AEs associated with current rosacea drugs/formulations resulted in treatment switch/discontinuation. New drug/formulation may provide additional treatment options for patients with AEs and lead to improved persistence and better symptom control.